Healthcare Provider Details

I. General information

NPI: 1760144943
Provider Name (Legal Business Name): BUTLER COUNTY COMMUNITY HEALTH CONSORTIUM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W SYCAMORE ST STE B
OXFORD OH
45056-1168
US

IV. Provider business mailing address

PO BOX 837
HAMILTON OH
45012-0837
US

V. Phone/Fax

Practice location:
  • Phone: 513-454-1111
  • Fax:
Mailing address:
  • Phone: 513-454-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: RYAN RANDALL
Title or Position: CFO
Credential:
Phone: 513-454-1468